Provider Demographics
NPI:1548390255
Name:WETTER, ROBYN FRIEDMAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:FRIEDMAN
Last Name:WETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:ANN
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1120 WAYZATA BLVD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1916
Mailing Address - Country:US
Mailing Address - Phone:952-476-6733
Mailing Address - Fax:952-476-0084
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3987
Practice Address - Fax:952-993-3663
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51825207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP73A00001Medicare PIN
KSP73000001Medicare PIN